Patients who have chronic HIV infection and are receiving suppressive ART display intestinal dysbiosis associated with increased microbial translocation and significant associations between specific taxa and markers of microbial translocation and systemic inflammation. This was an exploratory study, the findings of which need to be confirmed.

ABSTRACT. Objective: HIV and illicit drug use have been associated with altered nutrition, immune function, and metabolism. We hypothesized that altered composition and decreased diversity of the intestinal microbiota, along with microbial translocation, contribute to nutritional compromise in HIV-infected drug users. Method: We enrolled 26 men and 6 women, 15 HIV infected and 17 HIV uninfected, in this exploratory, cross-sectional study; 7 HIV-infected and 7 HIV-uninfected participants had used cocaine within the previous month. We examined the independent effects of cocaine use and HIV infection on the composition and diversity of the intestinal microbiota, determined by 16S rRNA gene pyrosequencing. Using dietary records, anthropometrics, and dual x-ray absorptiometry, we examined the additional effects of nutritional indices on the intestinal microbiota. We compared markers of infl ammation and microbial translocation between groups. Results: Cocaine users had a higher relative abundance of Bacteroidetes (M ± SD = 57.0% ± 21 vs. 37.1% ± 23, p = .02) than nonusers. HIV-infected individuals had a higher relative abundance of Proteobacteria (Mdn [interquartile range] = 1.56% [0.5, 2.2] vs. 0.36% [0.2, 0.7], p = .03), higher levels of soluble CD14 and tumor necrosis factor-, and lower levels of anti-endotoxin core antibodies than uninfected subjects. HIV-infected cocaine users had higher interferon-levels than all other groups. Food insecurity was higher in HIV-infected cocaine users. Conclusions: We identifi ed differences in the relative abundance of major phyla of the intestinal microbiota, as well as markers of infl ammation and microbial translocation, based on cocaine use and HIV infection. Nutritional factors, including alcohol use and lean body mass, may contribute to these differences. (J.

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Objective To evaluate changes in cardiovascular disease risk surrogate markers in a longitudinal cohort of HIV-infected adults over 6 years. Design Internal and common carotid artery intima-media thickness, coronary artery calcium, vascular and HIV risk factors were prospectively examined over 6 years in HIV-infected adults from 2002 to 2010. Setting Longitudinal cohort study with participants from urban center and surrounding communities. Subjects, participants 345 HIV-infected participants were recruited from a longitudinal cohort study. 211 participants completed the study and were included in this analysis. Main Outcome Measures Total and yearly internal and common carotid artery intima-media thickness change; coronary artery calcium score progression. Results Participants were 27% female and 49% non-white; mean age at start was 45 ± 7 years. The median change in internal and common carotid arteries over six years was 0.15mm (0.08,0.28) and 0.12mm (0.09,0.15), respectively. Age, baseline triglycerides ≥ 150mg/dL, and pack-years smoking were associated with internal carotid artery intima-media thickness change; age, cholesterol, nadir CD4+ count, and protease inhibitor use were associated with common carotid artery intima-media thickness change. Diabetes, HIV viral load, and HAART duration were associated with coronary artery calcium progression. Conclusions Carotid intima-media thickness and coronary artery calcium progressed in this HIV-infected cohort. Some HIV-specific characteristics were associated with surrogate marker changes, but the majority of risk factors continue to be traditional. Aggressive identification and management of modifiable risk factors may reduce progression of cardiovascular disease risk in this population.